Tag: medical coding

Introduction

Remote medical coding professional perks- working from home, no morning commute, flexible schedule, comfortable work clothes, ability to completely control your environment (room temperature, room lighting, sound considerations ) compared to other office workers to name just a few. But I know there is one area, that no one would list as a perk, and that is productivity, the job requirement to meet a number quota of so many charts per hour. I know some who might be neutral on the topic or proud that it’s not a struggle they have, but I have never meet anyone who loves this part of the job. Tolerate it, yes. Know that if you want to collect a paycheck it’s required, yes. Even be able to argue that it is within a company’s right to expect this from it’s employees in exchange for income, yes. However, I”ve never met anyone who loves this aspect of the job. Nobody will ever look at you with envy when you mention, “And I’m electronically monitored on the job, the numbers of charts I produce each day and if I don’t meet that number , I’ll have to talk to my boss about it . And each day I start at zero and I’ll have to fill my chart quota bucket accordingly. “

When the topic of working from home comes up, I’m often asked, “How do you not get distracted and do laundry, washes dishes or watch TV instead of work at your desk ?”. But really, thats not a temptation for me since I know I won’t meet my numbers if I do those things during non break times. Advanced computer programs allow a lot of monitoring now, so how I use my time exactly shows up as data and I work for a place that does daily reports on productivity and daily peer bench marking in terms of coding productivity. Computer generated reports show if I’m meeting those numbers or not.

But while it’s not something I love about my job, I work on getting more efficient with my coding so it’s not such a burden and I strive to manage the stress and not let it overwhelm me or sour my mood too much on the hard days. Here are some way’s I deal with the job requirement of productivity.

Here is an example from today. My second chart of the day was very complicated. It took three times what the standard chart take time wise. I need to complete 4.5 charts per hour. The time period when I did this chart, I ended up coding just two charts. I’m now in the hole 2. 5 charts and I’m only on my first hour of the day. My mind immediately goes to, “It’s going to be a bad day number wise. I won’t be able to make this up. It’s all downhill from here. I’m screwed. ” This is a dangerous attitude to have in terms of productivity because once you start to feel you can’t make the chart number quota for the day , you start to give up, you start to move through the chart slower and you start to diddle dwaddle since the day is no longer perfect. My progress is not moving in a straight line. It was looking like a no lunch, just snacks at the desk in order to save time day compounded now by my lack of enthusiasm and lost focus because the day is not going how I wanted.

But the afternoon had some pleasant surprises. I hit some very easy charts in the work queue, and was able up to make up the lost time and meet the numbers for the day. If the day was compared to a football game , it would have been similar to a game where the team was losing by two touch down’s at half time but had a miraclous fourth quarter and the team managed to win the game despite it’s rough start. To get the victory though in football and in coding, does require one to believe that it is possible, that you have the stamina and fortitude to pull it off. Giving up to quickly does not help.

Tip 2 : To increase your speed, increase your knowledge

I have been an outpatient surgical coder for a large, five hospital facility system for 3 years now. The surgery and observation team does not separate out the work by having certain coders code certain things such as some coders are only orthopedic coders or are spine coders or are gastrointestinal coders, etc. We code whatever chart we land on in the work queue. We are all general surgery coders for a trauma 1 hospital and 4 community hospital’s. My work day zig zags from colonoscopies, orthopedics, eye surgeries, hysterectomies, spine surgeries, gall bladder removals, all different surgeries. Because of that, I have a large span of things that I code and that I need to have some experience with in order to make the quality requirement of 96 % (a whole other blog post ) . There are some things that I only see every few months since the work is divided up between 14 other coders and some things are complications or just not your bread and butter typical surgeries like gallbladder removal or screening colonoscopy or breast lumpectomy. Because of this, I make it a point to save examples, notes, emails or other references I found helpful when I coded that difficult surgery the first time. I use to print these references and save them in binders, but now I use Microsoft OneNote which is a great program that has wonderful tabs and search options in it. My point is, make it easier for yourself in the future. By saving your insights, code selection or coworker emails now, that future chart will only take you twenty minutes instead of the 30 to 45 it took today because of all the extra research you had to do before you could complete it. Investment in your education today, brings added speed, mental energy and confidence later.

Tip #3: Set yourself up for success, pick hours that will bring maximum concentration and minimal distraction

I do best energy wise and mentally if I work early morning. The house is super quiet, I’m the only one up in my house and the computer system at work, runs faster since there are less people on the network and less emails going on to distract you. There are also less people in the work queue so you can move between charts faster also. Because of all these small factors, I’m a huge fan of early morning coding and code the most charts early morning. I lose speed as the day goes on.

I’ve also noticed, I do best with a broken up schedule. I like to work extra on Sunday so I can work shorter days during the week. I have coworkers who like to break up their hours, four hours in the morning, then an afternoon break of a few hours and then work again mid afternoon for four more hours. This is a job that requires a lot of sitting, staring at computer screens. On the bad day’s number wise, breakfast and lunch can be eaten at the desk to save time and bathroom breaks are minimal. A flexible or broken schedule can do wonders for your physical body and to refreshen your mind. Coding may not wear you out physically but it can be very tiring mentally.

Another energy tip that helps me is, if I land on a very difficult chart late afternoon in the coding queue , I will save that chart and code it tomorrow morning when I’m at my best and my mental energy bucket is full again. When I’m depleted mentally, I move slower and I can make more mistakes because I’m not thinking clearly. The best thing I can do in that moment is to save that chart and code it tommorow morning. I don’t always have that option, but if I do, that is my best line of defense to protect against coding mistakes and lost productivity due to being mentally tired.

This is just a small sample of ways to think about productivity. Everybody has their own personal way of dealing with it and improving. Some days its easy peasy to make the numbers and other days, I totally miss the mark. But I know its a requirement that is never going away so best to make my peace with it and manage it the best way I can.

Introduction

Today, I would like to write about the orthopedic knee procedure, tibia tubercle tuberosity osteotomy. The purpose of the surgery is to improve alignment of the patella. This is achieved by making a bony bridge from the tibia tubercle and moving it, with its attachment of the patella tendon more medially than its original location. A process often called by the Surgeon anteriormedialization translation (moving the patella tendon/tibia tubercle tuberosity medially on the anterior side of the knee) . Other common names for this procedure are:

Anatomy

The tibia tubercle is an oblong major bony ridge elevation on the tibia that provides an attachment point for the patella tendon. It acts as a lever for the patella tendon during extension and helps give the patella stability. If the patient is having patella instability, painful patella maltracking (patella is not staying in place) and symptoms of arthritis, one surgical option to correct this is tibia tubercle osteotomy (surgical cutting of a bone or a removal of a piece of bone.)

Procedure

The surgery initially begins with a diagnostic arthroscopic inspection (included in the surgery, not separately charged). Visual analysis of the articular cartilage takes place to see if there is any damage or defects in the cartilage. If found, a tool (burr, arthrocare ablation wand or shaver ) is attached to one of the scope’s. Next, debridement and shaving for clean up of the articular cartilage are done ( chondroplasty cpt 29877 can be charged if done). At the end of the arthroscopic section of the surgery, the scope is removed and the open procedure begins.

Now, the osteotomy , the cutting of the tibia tubercle begins.

An incision is made lateral to the patella and carried down along the distal anterior ridge of the tibia. Muscles involved in the extensor mechanism, over the anterior compartment are elevated. An incision is made through the periosteum of the tibia bone, distal to the tuberosity. K- wires are placed, a medial osteotomy is made that follows the plane of the K- wires followed by a lateral osteotomy cut. Oscillating saw and osteotome tools are used to perform these cuts. The tibial tuberosity is then repositioned in its new position. Patella tracking is assessed to check for misalignment or continued maltracking. Once proper alignment is achieved, one or more screws are drilled into the bone to secure the tibial tuberosity bony bridge in its new location.

To learn more about this procedure, check out this YouTube video on it. There are two other common patella procedures, I will blog on next.